Provider Demographics
NPI:1003357641
Name:FOSTER, DYLAN JAY (LLPC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAY
Last Name:FOSTER
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7185 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2329
Mailing Address - Country:US
Mailing Address - Phone:231-920-8749
Mailing Address - Fax:
Practice Address - Street 1:7142 CHIMNEY HILL DR
Practice Address - Street 2:APT 3205
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4535
Practice Address - Country:US
Practice Address - Phone:231-920-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451015391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional